PROPERTY RELEASE FORM / FIRE RELEASE FORM

• Date of alarm:

• Time of alarm:

• Address of alarm:

• Property owners name

• Property owners address if different than above

• property owners phone number

• property owners email

• Incident Occurrence Number:

• TYPE OF ALARM

• Structure Fire

• Working Smoke/Co detectors

  Yes

  No

  N/A

• Services isolated Hydro. Water. Natural gas. Oil. Propane. Other

  Yes

  No

  N/A

• Is the structure insured

  Yes

  No

  N/A

• Ins company name

• Policy number

• Chimney fire

• Working Smoke/co detectors

  Yes

  No

  N/A

• If no was one left

  Yes

  No

  N/A

• informed property owner that the chimney has to be wet certified before use and that FD needs a copy

  Yes

  No

  N/A

• Vehicle fire

• It the vehicle insured

  Yes

  No

  N/A

• Ins company name

  Yes

  No

  N/A

• Smoke/CO detector activation

• Co reading on arrival

• co reading at departure

• Public service call

• Medical response

• Was AED used

  Yes

  No

  N/A

• Was oxygen used

  Yes

  No

  N/A

• Patient refused assistance

  Yes

  No

  N/A

• Patient refused ambulance assistance

  Yes

  No

  N/A

Incident information

• Incident command name

Other Agencies

• Police

• Ambulance

• Hydro

• Gas company

• Social Services

• OFM

TIME SCENE RELEASE

• Time scene was released

  Date

• Owners signature

  Sign

• ICs signature

  Sign

• Witness signature

  Sign